Oral Appliance or CPAP??

The field of Dental Sleep Medicine is growing.  Obstructive sleep apnea (OSA) has always been a problem, but awareness of the severe health effects and the real cause is recent.  The resources to easily test and diagnose OSA were not readily available in the past.  Now virtually every large city has many accredited sleep centers.   Even now there are sleep centers in small communities.   This increase in our diagnostic abilities has lead to an increase in the number of patients being diagnosed with OSA.   An even better alternative to the sleep centers is the invention of the home sleep test (HST) equipment which is becoming widely used.  The Home Sleep Test allows you to get the diagnostic test you need in the comfort of your own home in your own bed.  Our office is a Comprehensive Sleep Center where you can come and have all your appointments in one place--our office.  You will not have to run around to several offices and hospitals to get your treatment completed.

Is It Just Snoring -- Or Is It Obstructive Sleep Apnea?

Snoring is mostly caused by vibration of the tissues of the throat and the soft palate.  Snoring may not only disturb the sleep of the bed partner, but it will fragment the sleep of the person snoring and it is usually a sign of OSA.  A very small number of people snore and do not have OSA.  This snoring occurs when the tissues of the throat and tongue collapse during sleep and block the airway.  A complete blockage for 10 seconds or more is called an apnea and the average apnea is 30 seconds.  A reduction of airflow of 40% or more with an oxygen reduction in the blood (desaturation) of 4% or more for 10 seconds or more is called a hypopnea.  The total of apneas and hypopneas measures the severity of OSA and is referred to as the apnea-hypopnea index (AHI).   5-14 events per hour of sleep is mild OSA, 15-29 events per hour of sleep is moderate OSA, and 30+ events per hour of sleep is severe OSA.  Our office has successfully treated patients with more that 60 events per hour!

The Old Standard

In the past, the only treatment for OSA was continuous positive airway pressure (CPAP).  While it was a breakthrough treatment, CPAP has some serious drawbacks.  About ten percent of those diagnosed with OSA are not willing to even try CPAP.   Of those who try CPAP, 20%-40% give up within one year.  Many of those who continue to use CPAP won't wear the mask long enough at night to achieve the benefits they need to resolve their sleep apnea.  The reasons they offer for discontinuing are many;

  • The mask fits poorly and is uncomfortable
  • The mask leaks or air leaks through the mouth
  • A skin reaction occurs or lines on the face are unsightly
  • The straps that hold the mask on create problems
  • Their bed partner complains of the noise of the system
  • Claustrophobia
  • Inability to clean properly; cleaning takes too long each morning
  • Dry nose or mouth and sinus problems
  • Dental problems

Biofilm Contamination Inside Masks and Tubing on CPAP

The inside of the reservoir, tubing, and masks of the CPAP get a biofilm on the surface.  A biofilm is defined as a growth of a mixture of microbes on a surface.  The HEPA filter does not prevent a biofilm from forming on the inside of the reservoir, mask, or tubing.  Below are pictures of various things which have been cultured from CPAP masks and tubing.  As you can see, there are many microbes on the equipment even after cleaning.



Oral Appliance Therapy ... The Solution For Sleep Apnea

A dentist trained like Dr. Johnson in treatment of OSA can help those patients who are CPAP intolerant.  According to American Academy of Sleep Medicine (AASM) guidelines, oral appliance therapy (OAT) is indicated as a first line therapy in mild and moderate OSA (AHI=5-29) and is also indicated in severe OSA (AHI=30+) when a patient has failed or refused CPAP.  Surgery is generally not successful with OSA.  The principle behind OAT is simple.  When a patient has obstructive sleep apnea, the airway is blocked by the tongue obstructing the airway during sleep.  The oral appliance (OA) keeps the lower jaw forward during sleep; since the tongue is attached behind the lower front teeth, moving the lower jaw forward will keep the tongue forward.  There are several appliances on the market that work well to achieve a reduction in AHI.  Knowing which appliance to use, how to adjust it, and treatment of side effects such as TMJ pain, myalgia, tooth movement, and bite changes is where the proper training of the dentist comes in.  And Dr. Johnson has that training.  See the Meet Dr. Johnson tab above to see his qualifications.

 But I Just Want To...

Often patients will say something like, "I just want to stop snoring" or "I just want to stop grinding my teeth."   They don’t know those are symptoms and that there probably is a much larger problem that is creating those symptoms.  They usually aren't aware of the fact that obstructive sleep apnea has severe consequences.  It affects not just the quality of life but can take years off of your life (an average of 8-10 years).  If their dentist only treats symptoms and ignores the underlying cause, they are doing patients a disservice.  They are putting patient's health at risk by treating snoring without a proper medical evaluation.

 There Is No Way To Tell By Just Looking

There is no quick way to know if they just snore or if they have OSA.  Accurate diagnosis and proper treatment is why it is important to be treated by an qualified dentist trained in oral appliance therapy.  Treating OSA is straight-forward.  The impact on a patient's life is awesome.  Dentists are in a position to be one of the main doctors to send patients to medical doctors for a referral  for sleep studies.  They spend much more time with patients than medical doctors do.  And they are looking right at the patient’s airway all the time!   At the "Northwest Treatment Center for Snoring & Sleep Apnea", we see many patients who just think that snoring is their biggest issue.    About 50% of couples sleep in different beds due to snoring; it has been listed as the 3rd leading cause of divorce!   It is important to know for sure what the real cause of their symptoms is.  Many patients who are clenching their teeth are doing so because they have an underlying sleep disorder.  They are, in effect, protecting the closing of their airway by clenching their teeth.  The brain is much more concerned about oxygen than it is about us hurting our teeth.

The Dentist's Role

The dentist’s role in the treatment of obstructive sleep apnea continues to expand.  The dentist is in a position to make an incredible contribution and literally add years to the lives and life to the years of many, many patients.  Dr. Johnson at the "Northwest Treatment Center for Snoring & Sleep Apnea" has been thoroughly trained in treatment of OSA by the top experts in the field.  Dr. Johnson is truly pleased to be in a position to help his patients literally change their lives by finally getting the restorative sleep that they have been missing.   If you snore, are tired during the day, or grind your teeth at night, you really need to find out if there is more to it than just those symptoms . If you sleep in a different room than your bed partner because of snoring, it may be because you have OSA.  You may have sleep apnea and your health is at risk.  Get an accurate diagnosis and let Dr. Johnson help you get relief and add years to your life.  If you are in the Spokane, Coeur d'Alene, or Post Falls area, you can get the relief you need in Coeur d' Alene by calling (844) 847-6673 to schedule your free consultation .